Simple hypertrophic tonsils have more active innate immune and inflammatory responses than hypertrophic tonsils with recurrent inflammation in children

Abstract

Background: Tonsil hypertrophy has negative impact on children's health, but its pathogenesis remains obscure despite the fact that numerous bacteriological studies have been carried out. Understanding the innate immune and inflammatory states of hypertrophic tonsils with different clinical manifestations is of great significance for defining the pathogenesis of tonsil hypertrophy and establishing treatment strategies. The present study was undertaken to examine the characteristics of innate immunity and inflammation in children with hypertrophic palatine tonsils and different clinical manifestations. Methods: Tonsil tissues were surgically removed from the patients and classified based on the patients' clinical manifestations. The patients were divided into three groups: 1) Control group; 2) Tonsil Hypertrophy (TH) group; and 3) Tonsil Hypertrophy combined with Recurrent Infection (TH + RI) group. The immune and inflammatory statuses of these tissues were characterized using qRT-PCR and ELISA methods. Results: Viral protein 1 (VP1) was highly expressed in TH group, but not in TH + RI group. In TH group, elevated expression was observed in the innate immune mediators, including retinoic acid-inducible gene I (RIG-I), interferon alpha (IFN-α), mitochondrial antiviral-signaling protein (MAVS), NLR family pyrin domain containing 3 (NLRP3), tolllike receptor (TLR) 4 and TLR7. Consistent with the innate immune profile, the expression of inflammatory markers (IL-1β, NF-κB and IL-7) was also significantly elevated in TH group. Meanwhile, the COX-2/PGE2/EP4 signaling pathway was found to be involved in the inflammatory response and the formation of fibroblasts. Conclusions: Innate immune and inflammatory responses are more active in simple hypertrophic tonsils, rather than hypertrophic tonsils with recurrent inflammation. A local relative immune deficiency in the hypertrophic tonsils may be a causative factor for recurrent tonsillitis in TH + RI. These differences, together with the patient's clinical manifestations, suggest that tonsillar hypertrophy might be regulated by diverse immune and/or inflammatory mechanism through which novel therapeutic strategies might be created.

Tonsillectomy and the incidence of various types of cancer

“…Large tonsils in adulthood may be more immunologically functional than small tonsils. This notion is in line with a recent study conducted in children [34], although the phenomenon is far from being explored satisfactorily. However, as mentioned above, the hypertrophic tonsils may also be indicators of increased susceptibility to infections, and it could be these infections which may lead both to tonsillectomy and progress to various cancers [3,5], especially when the tonsils are removed.…”

“…Retinoic acid–inducible gene I (RIG-I), interferon alpha (IFN-α), mitochondrial antiviral-signaling protein (MAVS), NLR family pyrin domain containing 3 (NLRP3), toll-like receptor (TLR) 4 and TLR7, and several inflammatory markers (such as IL-1β, NF-κB, and IL-7) have been shown to be highly expressed in simple hypertrophic tonsils (i.e. not in hypertrophic tonsils with recurrent tonsillitis), showing the activity of pathogen-induced innate immune responses [ 34 ]. Likewise, neutrophil–lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) have been determined as indicators of systemic inflammation in adults [e.g.…”

Occurrence of IL-1, IL-10, CD25, CD40, and CD69 in the tissue of palatine tonsils

“…IL-10) in both these conditions. Huang et al [39] found IL-1 and IL-10 in the hypertrophic palatine tonsil tissue as well as in hypertrophy with coexisting tonsillitis. The researchers demonstrated higher expression levels of the tested cytokines in the group with isolated hypertrophy.…”

Association of Prenatal Antibiotics and Mode of Birth With Otolaryngology Surgery in Offspring

“…6 Recurrent infections of the respiratory tract and allergic/atopic diseases contribute to pathologies, such as adenotonsillar hypertrophy and chronic middle ear effusions that may necessitate surgical management. 7–10 The causative pathogens and allergens are extremely widely distributed, but only a minority of children require otolaryngology surgery. Shared heritable and postnatal environmental factors, such as cigarette smoke, contribute modestly to differential risk.…”